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NHS commences gaming disorder treatment: when does enthusiasm become addiction?

Norman Murray

31 August 2018

The NHS begins treating its first gaming disorder patients this month.

From Fortnite to World of Warcraft, Candy Crush to Grand Theft Auto, the biggest video game titles have become household names. In this technology-driven 21st century, these goliath entertainment franchises are as influential and culturally referenced as anything in music, film or television. For some, gaming is a career. For the many, gaming is a way to unwind from the stresses of everyday life, and online gaming communities are an opportunity to build friendships with fellow enthusiasts.

But for a minority, gaming can be an all-consuming addiction.

Gaming addiction is to be listed as a mental health condition for the first time by the World Health Organisation. The draft document describes it as a pattern of persistent or recurrent behaviour so severe that it takes "precedence over other life interests". According to a paper by researchers who were involved in the process, the WHO was initially exploring excessive use of the internet, computers and smartphones, but determined from their research that the biggest concern resulting from these platforms was gaming. Some academics have suggested that the WHO has been under increased pressure, particularly from East Asian countries, to include the classification.

Game over

Some of the most populous and politically influential countries in East Asia have identified gaming as a public health issue and treated it as such for several years already. The South Korea government introduced a law banning access to online games between midnight and 6 am for children under the age of 16. In Japan, players are alerted once they hit a threshold of hours per month, while in China, internet firm and tech giantTencent has limited the hours that under-16s can access and play its most popular games.

But where is the line in the sand between enthusiasm and addiction, and who is drawing it? Does 20 hours of gaming a week constitute an addiction, or is it too complex to be measured in sheer blocks of hours?

Definition

The classification advises that abnormal gaming behaviour should be evidenced over a period of at least 12 months "for a diagnosis to be assigned" but added that period might be shortened "if symptoms are severe".

WHO have identified the key symptoms as:

impaired control over gaming (frequency, intensity, duration)

increased priority given to gaming

continuation or escalation of gaming despite negative consequences

This has led to obvious concern amongst some parents. The generational knowledge gap of the video game format between a 13 year old child and the 55 year old parent is understandable. A swift Google search unearths a world of worried parents commenting on Facebook and Twitter posts, pondering whether coming home from school and picking up a Xbox controller until bedtime is a sign of something more unsettling. How much is too much? Parents will naturally monitor their child’s gaming more attentively as gaming disorder becomes more talked about amongst parental groups, and as a result there will the children groaning in frustration at this unforeseen and unwelcome parental scrutiny.

"It could lead to confused parents whose children are just enthusiastic gamers" said Dr Richard Graham, lead technology addiction specialist at the Nightingale Hospital in London.

A recent study from the University of Oxford suggested that, although children spend a lot of time on their screens, they generally managed to balance their digital pastimes with daily life. The research - looking at children aged eight to 18 - also suggested the issue of imbalance is more prevalent in boys than in girls.

Personality

Is it the personality of the gamer, or the features of the games themselves, which sees some become hooked, while others manage to keep it strictly recreational?

Former snooker World Champion Neil Robertson spoke candidly in a recent interview with Eurosport about how his addiction has harmed his professional career. “I’m two months sober from playing [video games],” the Australian revealed. “My friend said to me: ‘you don’t get to choose the crack you are addicted to’. And the multiplayer online ones I can’t touch because I just get too hooked on them." He spoke of visiting China for a professional tournament and becoming incensed by the poor internet speeds affecting his ability to play. “I was furious for four or five days” he added. “All I was thinking about was getting back home for a [faster] connection”.

So far, experts disagree on whether or not such behaviour constitutes an addiction to games, whether games are by their very nature addictive, or whether excessive gaming is a symptom of a deeper, underlying issue.

We often think of addiction as tangible substances that the body suffers withdrawal symptoms from, such as heroin, cocaine, or alcohol. It was in 2013 that the Diagnostic and Statistical Manual of Mental Disorders reclassified gambling addiction as “gambling disorder” in its new behavioural addictions category, becoming the first officially recognised non-substance-based addiction disorder. The recognition of gambling disorder paved the way for gaming disorder.

In the early days of any emerging health concern, there is the fear of over-reaction and stigmatisation. Among the gaming community, there are many enthusiasts who suggest their pastime is already stigmatised enough. While gaming disorder could be a genuine problem for a small minority of gamers, there is a fear of concerned parents rushing to the conclusion that their child plays ‘too much’ and that this is detrimental to their mental health. Adult gamers will unlikely face such scrutiny.

Further research and a deeper understanding of the phenomena is required. The study of compulsive video game play is still in its infancy.